Hormonal
Pioglitazone (30 mg/day) improves NASH histology in non-diabetic patients, but its clinical use is limited by side effects including weight gain and potential cardiovascular risks.
Pioglitazone (30 mg daily for 96 weeks) can improve liver inflammation in non-diabetics, but it is rarely used first-line because it causes weight gain and has cardiovascular safety concerns. It is generally reserved for cases where other treatments are not suitable or available.
Pioglitazone treatment was associated with histological improvement in 34% of subjects compared with 19% of controls. ... concerns with the safety profile of TZDs (especially regarding cardiovascular safety of rosiglitazone) and a side effect profile that includes weight gain due to redistribution of body fat have led to poor acceptance of these agents for the treatment of NASH in clinical practice.
Why this rating
Based on the PIVENS RDBPCT, the largest trial of a PPAR-gamma agonist, though statistical significance was borderline (p=0.04) due to biopsy interpretation discrepancies.
Source
Current and upcoming pharmacotherapy for non-alcoholic fatty liver disease
Yaron Rotman et al. · Gut · 2016
DOI 10.1136/gutjnl-2016-312431
More from this paper
- Liraglutide (1.8 mg/day) induces histological resolution of NASH without worsening fibrosis in non-diabetic and diabetic patients, primarily by improving hepatic insulin sensitivity and reducing de novo lipogenesis, independent of weight loss magnitude.Good
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